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Brain-Numbing Complexities

April 22, 2011
by Mark Hagland, Editor-in-Chief
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In Healthcare, as in Neuroscience, the Issues are Always Multi-Faceted
Mark Hagland
Mark Hagland


A recent article in Science Daily reports that scientists are learning that our human brains are processing many more visual stimuli than we are consciously aware. Indeed, scientists at the Max Planck Institute for Brain Research in Frankfurt am Main, Germany, are finding that a lot of the visual information that reaches our brains through our eyes is processed, yet does not reach consciousness. In fact, they're learning, visual stimuli undergo a series of processing stages on their journey from the eye to the brain, meaning, in lay language, that we're constantly being bombarded with visual stimuli that don't even reach our consciousness.

In other words, as with countless other examples of other neuroscientific research, the more we learn about our brains, the more complex and multi-layered their functions turn out to be. And doesn't that sound a lot like healthcare?

Every time a new healthcare policy concept germinates, garners attention, undergoes scrutiny, and then becomes a part of a legislative or regulatory framework and, ultimately, gets turned into a mandate or cluster of mandates, somewhere along the way, healthcare policy and industry leaders come to realize how complex it all is in reality. For example, as providers begin to try to turn the concepts of accountable care groups, bundled payments, and the patient-centered medical home into actual working arrangements, they are quickly realizing that the number of “moving parts” involved in every one of these concepts is immense. And experts are already warning that mastering this particular challenge is going to be far more difficult than many now realize.

That certainly is true when it comes to physician documentation. With all the data reporting requirements coming out of the meaningful use process under the HITECH Act, a new spotlight is focusing, not surprisingly, on this area, as large amounts of data will eventually have to be drawn automatically into reporting mechanisms out of physicians' progress notes and history and physical summaries. But here's the rub: physician documentation is so weighed down already with so many purposes-including clinician-to-clinician communication, billing support, and data analysis-that figuring out how to meet the M.D. documentation-related elements of MU work while still respecting and supporting physicians' fundamental needs in this area is turning out to be extremely complicated.

As we report in this month's cover story, a small number of organizations, including Texas Health Resources, Adventist Health System, University of Pittsburgh Medical Center, and, on the medical group side, Southeast Texas Medical Associates, are beginning to make significant inroads in moving forward to optimize physician documentation processes, for everyone's sake.

That doesn't mean that any of this is easy, of course. Indeed, the physician documentation conundrum is so very typical of healthcare, in that, once one looks just below the surface, everything is all very tangled, and, frankly, confused. It's like the proverbial knit sweater with the small snag in its fabric-if you pull on just the snag, the whole thing starts to unravel.

As with other tangled areas in healthcare, this one calls out for fresh approaches and ingenious solutions. At base, we've simply have to support our doctors in their efforts to provide the best patient care, while also working to meet the laudable goals of meaningful use.

In the end, getting this piece of the healthcare delivery mosaic right will be yet another highwire act. One can hope that, with all the right neurons in our brains firing, we as an industry can get this bit right after all.

Mark Hagland, Editor-in-Chief Healthcare Informatics 2011 May;28(5):06



Those who resist electronic patient records argue that EMR records are repetitious and look very much the same from patient to patient. Interestingly, looking at transcript shows the same redundancy. The argument about free tests versus structured data continues, but the reality is that the auditing and analytic capability provided by EMR far outweighs any complaint of "sameness" about records.

Data analysis is the foundation of the future of healthcare and it cannot happen without electronic records. Attention must be paid to specificity of data capture with EMR but there is no argument which mitigates against the advance to electronic records.

Inpatient records computer generated by health care providers requires more creativity to leverage the power of electronics with the granularity of language and free text, but it can and is being done. The key is automated data sharing through HIEs and dynamic interfaces.
James L. Holly, MD